Clinical Feature:
The patient was a 40-year-old man who suffered from penetrating chest
trauma with left atrium and right ventricle injuries two days before
being referred to our hospital following a street fight. He had
undergone repair of cardiac tears at a hospital outside the city, by a
general surgeon.
He was still complaining of chest pain after being transferred to the
intensive care unit. In the first place, the pain caused by surgery was
taken into account but after taking an electrocardiogram and seeing Q
wave formation and ST-segment elevation in the antroseptal leads, he was
referred to our center with suspicion of damage to the left anterior
descending artery (LADA).
At the time of admission, his vital signs were stable. Echocardiography
revealed akinesia in apical and antroapical and antroseptal walls with
global left ventricular ejection fraction (LVEF) about 30 %. Coronary
angiography was done and LADA was cut off at mid part. We decided to try
angioplasty by crossing a 0.014″ wire but any attempt failed (fig1).
Assuming that the artery was ligated during heart repair by sutures and
due to the fact that the patient was stable and three days had passed
since his heart attack, we decided to follow the patient. He was
discharged in good general condition after three weeks.
Two months later, he complained of chest pain in functional class II.
Echocardiography revealed LVEF about 50%. Coronary angiography was
performed and showed LADA with good distal run off after previous site
of occlusion (fig2). Therefore, the patient was a candidate for bypass
surgery and revascularization of LADA was performed with harvested LIMA,
successfully. The surgeon had reported ligation of LADA by some sutures
during previous cardiac repair. After a week he was discharged in good
condition.